Your fertility plan should be too.
Polycystic ovary syndrome is a condition that can affect the ability of women of childbearing age to conceive.
Polycystic ovary syndrome is considered one of the most common hormonal disorders in reproductive-aged women, affecting 1 in 10 women of childbearing age in the U.S. While the exact cause of PCOS is currently unknown, many experts think that genetics may be a factor.
Typically, women with polycystic ovary syndrome struggle with infrequent or lack of ovulation and evidence of increased androgen sex hormones (like excessive or male-pattern hair growth and acne). However, some women will have fewer outward signs of the syndrome. There is currently not “one test” to diagnose PCOS. A doctor can diagnose polycystic ovary syndrome by taking a thorough menstrual history, performing an ultrasound of the ovaries and a few hormone blood tests.
Women often become concerned about polycystic ovary syndrome when they are trying to have a baby. When the female body produces elevated levels of androgen hormones, including the hormone testosterone, it can cause a woman’s ovaries to not properly develop a mature egg for release (ovulation) each menstrual cycle. Without ovulation, sperm and egg do not get a chance to meet, making it impossible to get pregnant naturally.
In our clinic, most often we diagnose a woman with PCOS because her menstrual cycles are irregular and she is having trouble getting pregnant, which is a symptom of polycystic ovary syndrome.
However, not all women with polycystic ovary syndrome experience the same symptoms.
These symptoms can often lead to anxiety and depression. Women experiencing any number of these symptoms should see their OB/GYN for further evaluation. If fertility is specifically a concern, a fertility specialist (called a reproductive endocrinologist) is recommended.
Because a hormonal disorder can affect the whole body, symptoms can affect different aspects of a woman’s health. These include menstruation irregularity or lack of menstruation, dermatologic conditions, metabolism health, and other functions.
For example, infrequent or lack of menstruation disrupts a regular menstrual bleed, causing the lining of the uterus to become thick. This ultimately could lead to the development of pre-cancerous cells or uterine cancer.
The overproduction of androgens during PCOS may also be linked to a decreased efficiency of insulin hormone regulation. Insulin is a vital hormone that converts sugars and other foods into energy. The dysfunctional regulation of insulin in some women with polycystic ovary syndrome may also play a role in their difficulties with ovulation. It is also likely why women with PCOS appear to have a higher risk of developing diabetes.
Metabolic syndrome is also associated with polycystic ovary syndrome. It results in a variety of conditions, from high blood pressure and cholesterol to insulin resistance and diabetes. All of these conditions can increase a woman’s risk of heart disease.
PCOS presents differently in each individual.
In order to reach a diagnosis of PCOS, physicians must identify two of the following three criteria:
PCOS is technically a diagnosis of exclusion, meaning other conditions that can look like polycystic ovary syndrome must be ruled out. Unfortunately, patients are often inappropriately diagnosed with PCOS without completing all of the testings to formally rule out other conditions that can mimic PCOS. These conditions require specific treatment that often differs from the treatments for polycystic ovary syndrome.
Treatment for PCOS is individualized, depending on a patient’s goals and symptoms.
If a woman is not trying to become pregnant in the immediate future, often birth control pills are prescribed to help reduce the impact of increased androgens (acne and hair growth) and restore a normal menstrual pattern, which is important to reduce the risks associated with the build-up of menstrual lining without a regular bleed. If women would like to avoid using birth control pills, cyclic progesterone or even an IUD (intrauterine device) can be used to reduce risks related to the uterine lining, while other medications, such as spironolactone, can be used to reduce hair growth.
For those who hope to become pregnant, oral ovulation induction with medications such as clomiphene citrate or letrozole is often effective. However, about 30 percent of women will not ovulate even with high doses of these medications and may require injectable hormones to stimulate ovulation. If these treatment options do not result in a successful pregnancy, a physician may recommend more advanced reproductive technology, such as in vitro fertilization (IVF).
For women looking to manage long-term complications of PCOS, maintaining a healthy diet and exercise routine is essential. They should also have regular screening for diabetes and cholesterol as recommended by their primary care provider.
At this point, there is no clear way to determine if a woman will develop PCOS and no “cure.”
So there are no specific steps a woman can take to try to prevent PCOS. However, family history of diabetes, infertility, or obesity can be important indicators.
Diagnosing PCOS early can help a young woman manage the symptoms and decrease the chances of long-term complications related to developing diabetes, infertility, and heart disease. All women living with polycystic ovary syndrome, regardless of the desire to conceive or bodyweight, can benefit from a healthy lifestyle with regular exercise and good food choices.